A population-based study of sociodemographic and clinical factors among children and adolescents with opioid overdose.

STUDY OBJECTIVE: An upsurge of high-risk opioid misuse has contributed to the epidemic of opioid overdose in the United States. The primary aim was to report the rate of opioid overdose among the pediatric population and to report demographic and medical differences among POD versus IOD populations. DESIGN: Retrospective descriptive analysis of opioid overdose using the largest pediatric inpatient database in the United States. We performed a Pearson chi-square and Wilcoxon rank sum test to compare differences between cohorts. SETTING: Multi-institutional. PATIENTS: Data were obtained from the Kids' Inpatient Database of the Healthcare Cost and Utilization Project. We used the International Classification of Disease, Ninth Revision codes to extract records of pediatric patients who were admitted for POD or IOD from 2000 to 2012. INTERVENTIONS: None. MEASUREMENTS: None. MAIN RESULTS: The final analysis included 15,884 patients admitted to a United States hospitals with opioid overdose. The rate of POD and IOD has increased steadily from 2000 to 2012. Black, Asian or Pacific Islander, Native American, Multi-race, and Unknown race had higher proportion of POD versus IOD (p < 0.001). Compared to POD, the rate of IOD was highest in Northeast (29.2% versus 14.3%, p < 0.001) and Midwest (31.6%versus 26.1%, (p < 0.001) regions of the country. CONCLUSIONS: Our findings reinforce existing studies that report a continued rise in opioid morbidity and mortality while providing new insights into sociodemographic patterns and comorbidities associated with POD versus IOD.

Prediction Model for Extended Hospital Stay Among Medicare Beneficiaries After Percutaneous Coronary Intervention.

OBJECTIVE: The authors conducted a retrospective analysis to develop a predictive model consisting of factors associated with extended hospital stay among Medicare beneficiaries undergoing percutaneous coronary intervention (PCI). DESIGN: Retrospective cohort study. SETTING: Multi-institutional. PARTICIPANTS: Data were obtained from the National (Nationwide) Inpatient Sample registry from 2013 to 2014 over a 2-year period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was extended hospital stay, which was defined as an inpatient stay greater than 75th percentile for the cohort (≥5 d), among Medicare beneficiaries (fee-for-service and managed care) undergoing PCI. A multivariable logistic regression analysis was built on a training set to develop the predictive model. The authors evaluated model performance with area under the receiver operating characteristic curve (AUC) and performed k-folds cross-validation to calculate the average AUC. The final analysis included 91,880 patients. Inpatient hospital length of stay ranged from 0 to 247 days, with 3 and 5 days as the median and 3rd quartile hospital stay, respectively. The final multivariable analysis suggested that sociodemographic variables, hospital-related factors, and comorbidities were associated with a greater odds of extended hospital stay (all p < 0.05). The use of PCI with drug-eluting stent was associated with a 31% decrease in extended hospital stay (odds ratio 0.69, 95% confidence interval 0.66-0.72; p < 0.001). Model discrimination was deemed excellent with an AUC (95% confidence interval) of 0.814 (0.811-0.817) and 0.809 (0.799-0.819) for the training and testing sets, respectively. CONCLUSION: The authors' predictive model identified risk factors that have a higher probability of extended hospital stay. This model can be used to improve periprocedural optimization and improved discharge planning, which may help to decrease costs associated with PCIs. Management of Medicare beneficiaries after PCI calls for a multidisciplinary approach among healthcare teams and hospital administrators.